Patient Care Endocrinology & Cardiology - October 2007 - (Page 15)

Metabolic syndrome I TABLE 2 ed serum liver enzymes. The precise sequence of events leading to the development of fatty liver is not yet fully understood. Evidence suggests that as many as 43% of women with PCOS also have the metabolic syndrome.27 These disorders have many features in common, particularly among women with the highest insulin levels and BMI. In one study, the PCOS subjects in the top BMI quartile were 13.7 times more likely to have the metabolic syndrome, compared with those in the lowest quartile.28 Hyperinsulinemia is a likely common pathogenic factor for both PCOS and the metabolic syndrome. Treating the metabolic abnormalities of PCOS with metformin (Glucophage) and thiazolidinediones has been successful in improving the symptoms of PCOS and inducing menstruation and ovulation. The relationship between the metabolic syndrome and various cancers (colon, breast, prostate) has been shown in multiple studies. Although the mechanisms are unknown, one hypothesis involves the effect of insulin resistance and hyperinsulinemia on inhibiting insulin-like growth factor (IGF) binding proteins, thus increasing available IGF-1, a known mitogen and cell survivor factor. 26 Factors and conditions associated with the metabolic syndrome Complications Atherosclerotic cardiovascular disease Diabetes mellitus Diseases Gestational diabetes Polycystic ovary syndrome Obstructive sleep apnea Depression Gallstones Prostate cancer Chronic kidney disease Medications Antipsychotics Older protease inhibitors Nutritional factors High carbohydrate/fat diet High alcohol intake Higher intake of milk/dairy products Higher intake of dietary and supplemental calcium 25-Hydroxy vitamin D deficiency TREATMENT AND PREVENTION STRATEGIES The primary goals of managing the metabolic syndrome and prediabetes for primary care physicians are to reduce the risk of CHD and diabetes. Even in patients with established diabetes, intensive management of the metabolic syndrome will diminish the higher risk of CHD. All components of the metabolic syndrome can be improved through a global strategy addressing the underlying risk factors— hypertension, abdominal obesity, prediabetes, physical inactivity, and an atherogenic/diabetogenic diet—by means of nonpharmacologic and pharmacologic approaches. Nonpharmacologic approaches Patients usually experience difficulty in changing their lifestyles. Setting specific realistic goals and making use of support-group counseling and group visits can help promote adherence. The National Diabetes Education Program recommends 6 steps that health care professionals can use for treatment of prediabetes. These include identifying and testing high-risk patients, discussing treatment options, setting realistic weight-loss goals, setting attainable dietary and exercise goals, initiating lifestyle modifications, and referring for weight-loss support. Lifestyle modification comprises the 2 main areas of diet and exercise, with the goals being weight reduction and improvement of metabolic parameters. Attention to salt intake can also be helpful for most patients. Weight reduction should be the first priority in persons with hypertension, abdominal obesity, prediabetes, and the metabolic syndrome. A weightreduction diet has been shown to improve all components of the metabolic syndrome. This is best achieved by decreasing daily caloric intake and increasing physical activity. Over 12 months, a weight loss of 7% to 10% will usually require a OCTOBER 2007 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY 15

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Patient Care - Endocrinology & Cardiology - October 2007 Research Digest Contents Medicine in the News Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes Using Troponins to Evaluate Cardiac Injury The 15-Minute Visit Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - October 2007

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